5.3 Professional Liability and Your Nursing License
As discussed in the previous sections, professional liability occurs when a civil lawsuit compensates clients who allege they have suffered injury or damage as a result of professional negligence. Many nurses elect to purchase malpractice insurance to protect themselves from professional liability, especially if working in specialty areas that experience a high number of claims, such as in obstetrics or post-anesthesia care units (PACUs). The Nursing Service Organization (NSO) works in association with the American Nurses Association to provide malpractice insurance for nurses interested in purchasing it.
Read more about malpractice insurance available for nurses at https://www.nso.com/.
The civil justice system cannot make rulings regarding your nursing license. It is the responsibility of the State Board of Nursing to suspend or revoke an individual’s nursing license based on a disciplinary process.
The State Board of Nursing (SBON) governs nursing practice according to that state’s Nurse Practice Act. The purpose of the SBON is to protect the public through licensure, education, legislation, and discipline. A nursing license is a contract between the state and licensee in which the licensee agrees to provide nursing care according to that state’s Nurse Practice Act. Deviation from the Nurse Practice Act is a breach of contract that can lead to limited or revoked licensure. The SBON can suspend or revoke an individual’s nursing license to protect the public from unsafe nursing practice. Nursing scope of practice and standards of nursing care are defined in the Nurse Practice Act that is enacted by the state legislature and enforced by the SBON. Nurses must practice according to the Nurse Practice Act of the state in which they are providing client care.
A nurse may be named in a board licensing complaint, also called an allegation. Allegations can be directly related to a nurse’s clinical responsibilities, or they can be nonclinical (such as substance abuse, unprofessional behavior, or billing fraud). A complaint can be filed against a nurse by anyone, such as a client, a client’s family member, a colleague, or an employer. It can be filed anonymously. After a complaint is filed, the SBON follows a disciplinary process that includes investigation, proceedings, board actions, and enforcement. The process can take months or years to resolve, and it can be costly to hire legal representation.[1]
During the investigation process, investigators use various methods to determine the facts, such as interviewing parties who were present, reviewing documentation and records, performing drug screens (if impairment is alleged), and compiling pertinent facts related to the events and circumstances surrounding the complaint. Nurses being investigated may receive a letter, email, or phone call from the SBON, or they may be required to appear at a certain date and time for an interview with an investigator. It is recommended that nurses consult with an attorney before responding to the SBON within the deadline provided. Nurses should be cooperative but should be aware that whatever is shared will be provided to a prosecuting attorney and/or the SBON.[2]
After completion of the investigation, the prosecuting attorney will determine how to proceed. A conference may be scheduled where the nurse will be interviewed by a member of the SBON and possibly the prosecuting attorney. It is recommended for the nurse to have an attorney present during proceedings. The nurse has the opportunity to present evidence supporting their case. A resolution may be offered after the conference that ends the matter.[3]
However, if the SBON believes there is significant evidence, a formal hearing is held where a disciplinary action is proposed. This formal hearing is similar to a civil trial. The hearing panel may include some or all of the SBON members. A court reporter records the entire proceeding and a transcript is created. Witnesses may be called to testify and the nurse undergoes cross-examination. When both sides have presented their cases, the hearing is concluded. The outcome of the formal hearing is a ruling by the administrative law judge and the SBON. The nurse may face disciplinary action such as a reprimand, limitation, suspension, or revocation of their license. Nondisciplinary actions, such as a warning or a remedial education order, may be set. See a description of possible disciplinary actions enforced by the Wisconsin State Board of Nursing in Table 5.3a.
Table 5.3a. Potential Disciplinary and Nondisciplinary Actions of the Wisconsin State Board of Nursing[4]
| Disciplinary Options
|
Reprimand: The licensee receives a public warning for a violation.
Limitation of License: The licensee has conditions or requirements imposed upon their license, their scope of practice, or both. Suspension: The license is completely and absolutely withdrawn and withheld for a period of time, including all rights, privileges, and authority previously conferred by the credential. Revocation: The license is completely and absolutely terminated, as well as all rights, privileges, and authority previously conferred by the credential. |
|---|---|
| Nondisciplinary Options | Administrative Warning: A warning is issued if the violation is of a minor nature or a first occurrence, and the warning will adequately protect the public. The issuance of an administrative warning is public information; however, the reason for issuance is not.
Remedial Education Order: A remedial education order is issued when there is reason to believe that the deficiency can be corrected with remedial education, while sufficiently protecting the public. |
Find and review your state’s Nurse Practice Act at https://www.ncsbn.org/policy/npa.page.
Read more about Wisconsin’s Board of Nursing and Administrative Code.
Liability considerations does not only apply when working in your professional nursing role, but also within your student nurse role. As you work as a student nurse, there are other role considerations which may impact the decision regarding professional liability. Please see Table 5.3b for a comparison of different types of liability.
5.3b. Types of Liability
| Type of Liability | Definition | Example |
| Supervisory Liability[5] | When a clinical supervisor or preceptor is held responsible for the actions of the student nurse or for failing to properly supervise them. | A clinical supervisor fails to provide proper guidance during a procedure, resulting in the student nurse administering the wrong medication to a client. The supervisor could be held liable for inadequate supervision. |
| Institutional Liability[6] | When the health care institution (e.g., hospital, clinic) is held responsible for the actions of its employees or for failing to implement adequate policies and procedures to prevent harm. | A hospital does not provide proper orientation or training programs for student nurses, leading to a student nurse making a critical error. The hospital could be held liable for not ensuring adequate training. |
| Student Liability[7] | When the student nurse is held responsible for their own actions that cause harm to clients or violate protocols. | A student nurse neglects to follow infection control protocols, resulting in a client’s condition worsening. The student nurse could be held liable for their negligence. |
- Nurses Service Organization (NSO) and CNA Financial Corporation. (2020). Nurse professional liability exposure claim report: 4th edition: Minimizing risk, achieving excellence. https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
- Nurses Service Organization (NSO) and CNA Financial Corporation. (2020). Nurse professional liability exposure claim report: 4th edition: Minimizing risk, achieving excellence. https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
- Nurses Service Organization (NSO) and CNA Financial Corporation. (2020). Nurse professional liability exposure claim report: 4th edition: Minimizing risk, achieving excellence. https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
- Wisconsin Department of Safety and Professional Services. (2021). Board of nursing newsletter. https://content.govdelivery.com/accounts/WIDSPS/bulletins/2d71e3d ↵
- Dyer, A. M. & Griffin, S. (2024). Just culture, liability concerns, and ensuring a safe working environment. AOCN, Association of periOperative Registered Nurses. https://www.aorn.org/article/just-culture#:~:text=This%20is%20called%20vicarious%20liability,the%20nurse's%20scope%20of%20practice ↵
- Oliva, A., Caputo, M., Grassi, S., Vetrugno, G., Marazza, M., Ponzanelli, G., Cauda, R., Scambia, G., Forti, G., Bellantone, R., & Pascali, V. (2020). Liability of health care professionals and institutions during COVID-19 pandemic in Italy: Symposium proceedings and position Statement. Journal of Patient Safety 16(4), e299-e302. https://doi.org/10.1097/PTS.0000000000000793 ↵
- Nurses Service Organization (NSO) and CNA Financial Corporation. (2020). Nurse professional liability exposure claim report: 4th edition: Minimizing risk, achieving excellence. https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
When a clinical supervisor or preceptor is held responsible for the actions of the student nurse or for failing to properly supervise them.
When the healthcare institution (e.g., hospital, clinic) is held responsible for the actions of its employees or for failing to implement adequate policies and procedures to prevent harm.
When the student nurse is held responsible for their own actions that cause harm to patients or violate protocols.